Predominant cognitive phenotypes in MS: insights from patient-centered outcomes (PCOs)

Young Investigator
Jessica Podda
Italian Multiple Sclerosis Foundation
70
Genua, Italy

Abstract

In MS, cognition is typically considered dichotomously (impaired or not-impaired) leading to heterogeneous groups of cognitively compromised patients. A step toward the development of effective targeted treatments for cognition in MS is to first recognize predominant subgroups (cognitive phenotype) of patients who manifested specific patterns of cognitive impairments (CI). The aim of this study was to apply latent class analysis (LCA) to identify distinct cognitive phenotypes based on the combination of CI and mood disorders (MD), deemed to be the most disturbing deficits in MS.

Data from 827 PwMS within the ongoing Italian PROMOPRO-MS initiative were analyzed. Demographic (gender, age, years of education) and clinical (disease duration, disease course, EDSS) information were collected. MoCA and SDMT were administered to provide information about global cognitive functioning and information processing speed (IPS), respectively. HADS was administered to evaluate depression and anxiety symptoms.

LCA identified four distinct and predominant cognitive phenotypes that could be conceptualized as a continuum: from younger patients with a lower EDSS, a relapsing-remitting disease course, fewer and restricted CI (phenotype 1: 28.3%; n = 247) and with accompanying MD (phenotype 2: 21.2%, n = 185), passing by individuals with higher CI in more than two cognitive domains (i.e., memory, language and attention) (phenotype 3: 18.8%, n = 164), to older patients with a marked and global alteration of cognitive functioning (i.e., attention, memory, language, IPS, executive functions) combined with a more severe clinical profile (i.e., higher EDSS and progressive disease course) (phenotype 4: 31.7%, n = 276). Since less is known about the longitudinal progressive deterioration of cognitive skills in PwMS, a taxonomy of distinct subtypes that consider both CI and other relevant dimension that affect MS represents both a challenge and an opportunity for an advance understanding of CI and development of tailored treatments for cognition in PwMS.

Predominant cognitive phenotypes in MS: insights from patient-centered outcomes (PCOs)

Jessica Podda 1 (main author), Michela Ponzio 1, Ludovico PedullĂ  1, Margherita Monti Bragadin 1,2, Mario
Alberto Battaglia 3, Paola Zaratin 1, Giampaolo Brichetto 1,2, Andrea Tacchino 1
1 Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
2 AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
3 Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy